Spontaneous Pneumomediastinum with Concurrent Pneumopericardium in a Young Woman with Asthma: Clinical-Radiological Correlation and Conservative Outcome

Abstract

Spontaneous pneumomediastinum (SPM) is a rare and usually benign condition characterized by the presence of free air in the mediastinum without an evident traumatic or iatrogenic cause. Although classically described in young men, it may occur in women and in association with multiple precipitating factors. We report the case of a 32-year-old woman with poorly controlled asthma who presented with acute dyspnea and chest pain. Chest computed tomography confirmed extensive pneumomediastinum associated with pneumopericardium, without evidence of esophageal rupture or pneumothorax. Additional potential triggers included recent intensive weight training involving Valsalva maneuvers and the use of veterinary-origin anabolic steroids, suggesting a multifactorial mechanism of alveolar rupture. Transthoracic echocardiography excluded cardiac tamponade. The patient was managed conservatively with symptomatic support and optimization of asthma therapy, with favorable clinical and radiological evolution. This case highlights the importance of recognizing SPM and pneumopericardium in the differential diagnosis of acute chest symptoms, as well as the role of combined mechanical and inflammatory factors in its pathophysiology, reinforcing that conservative management is safe and effective in clinically stable patients.